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C` <br /> • <br /> •NEW-SECURITY-INTEREST HOLDERS <br /> Security-interest holder name: <br /> cd <br /> Mailing address: <br /> L <br /> u <br /> rn <br /> Security-interest holder name: <br /> Mailing address: <br /> V <br /> Buyer/new owner acknowledgement of sale/change of ownership <br /> I affirm that the information provided herein accurately reflects the ownership of the structure at the completion of the <br /> asale/change of ownership. <br /> I understand that the home cannot be relocated without first completing this form and purchasing a trip permit from the <br /> State of Oregon, Building Codes Division or one of its county agents. <br /> g I understand that the seller/owner is responsible for submitting this Ownership Document Application to the State of <br /> g Oregon, Building Codes Division or one of its county agents within 30 days after closing of the sale, and that all <br /> buyers and sellers will be notified by mail when the application is completed. I understand that,should the seller/owner <br /> >, fail to file this Ownership Document Application within 30 days, I may complete the filing[ORS <br /> understand that each lessor, mortgagee, trust-deed beneficiary, lien holder of record, and security-��erestlholder must r <br /> be listed on this notice, or, if none are listed, the manufactured structure must be free and clear of all mortgages, deeds <br /> of trust,security interests,and liens. <br /> Bu, er/new owner name• uirtt Ri ht of survivorship r`Btiyer/new ownet sr nature, <br /> Y-- -- --_ (/. )�� g � fig .�.._. ,Date: <br /> a ;Buyer/new name.owner nint: , - - <br /> _.. a-_ �p?; ).,, ❑ Right of survivorship et'/new.ow.ner signature;) ;rD>Itc:; <br /> v <br /> Buyer/new owner name(pilot): ❑ Right of survivorship Buyer/new owner signature: <br /> Date: <br /> Buyer/new owner name(print): ❑ Right of survivorship Buyer/new owner signature: Date: <br /> Seller/current owner acknowledgement of sale/change of ownership <br /> Application must be accompanied by the appropriate valid County Manufactured Home Notification form, <br /> All owners must release their interest or acknowledge this sale/change of ownership in the structure in order to <br /> complete this application.All current owners, including security-interest holders, must acknowledge the sale/change of <br /> • <br /> ownership by signing the ownership document or DMV title or completing the section below. Security-interest holders <br /> may elect to acknowledge the sale/change of ownership, but maintain their security interest until such time as they no <br /> longer have an interest in the home. <br /> Seller/current owner affidavit I affirm that I am the current owner of this structure and acknowledge that the seller is <br /> responsible for submitting notice of sale/change of ownership to the State of Oregon Building Codes Division or one of <br /> its county agents within 30 days of the closing of the sale [ORS 446.641(1)]. <br /> 44(1-2952(7/17/COM) Page <br /> 4 <br />